Application materials will be accepted until February 5, 2016. Complete the application below, including uploading of required documents.

To complete the application process, we require: 1) A CV; 2) a personal statement (300 words or less) describing your motivation and goals for participation in the CRIT Program, and the percentage of time teaching during your Chief Residency. Relate your interest in addiction medicine to your previous training, upcoming Chief Residency, your career aspirations, and how you will apply the knowledge gained at the CRIT Program; 3) a letter of nomination from your residency program director detailing the percentage of time in chief residency dedicated to teaching;and 4) a letter of support from a faculty member (mentor) who will support the integration of addiction medicine into your institution's curriculum. If your Residency Director is also your mentor, please have this stated in just one letter

These letters to complete the application ought to be sent by the deadline to the Program Manager at danna.gobel@bmc.org

Note Exception: If your faculty mentor is applying along with you and completing a FM CRIT Application, his/her application will serve as this letter of support.

The CRIT Program is funded by a grant from the National Institute on Drug Abuse (NIDA). You will be asked to complete several surveys, which we will send to you. Your survey will not be available to program applicant reviewers and will not influence whether or not you are accepted. Your application will not be considered complete until you have returned the pre-course survey.

Name*

FirstLast

Preferred First Name/Nickname (as you would like it on your badge should you get accepted to the program)

Please approximate the percentage of time you will spend teaching during your Chief Residency.

What are your plans upon completion of your Chief Residency? (Check any or all that apply)

Fellowship

Clinician Educator

Research

Full-time Clinical Practice

Academic Medical Center Practice

Private Practice

Other

How did you hear about the CRIT Program?*

Previous CRIT Program attendee

Faculty at my institution

Brochure or postcard advertising the Program

Internet search

Other (describe below)

Please describe "other"

Please provide a statement (up to 300 words) describing your motivation and goals for participation in the CRIT Program, and the percentage of time teaching during your Chief Residency. Relate your interest in addiction to your previous training, upcoming chief residency, your career aspirations, and how you will apply the knowledge gained at the CRIT Program. Please include your NAME and DATE in the header and upload the statement as a PDF document here.*